Sterile processing: How hospitals can maintain patient safety amid an ever-changing field

An aging patient population and an increasingly consumer-driven healthcare environment fuel the demand for quick, convenient surgical procedures. The tools used in these procedures are more sophisticated than previous generations of medical instruments — meaning they are also more difficult to effectively clean.

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Consequently, many hospitals today find themselves reevaluating their sterile processing departments and selecting new equipment to meet their infection control needs. This reexamination is partially driven by the new minimally invasive surgery devices entering the market, a trend that only compounds hospitals' and health systems' deep-rooted commitment to patient safety and infection control compliance.

Hospitals' sterile processing needs are changing

With such serious health and financial consequences, reducing HAIs represents an unwavering priority for hospitals. However, the tools and strategies required to prevent these infections often change in conjunction with industry trends.

Consider that each new surgical device designed to improve patient care requires infection control professionals to develop new, custom protocols to ensure cleanliness and quality for repurposing. Here are four key factors that drive change in hospitals' sterile processing equipment needs.

1. Heightened emphasis on reducing infection rates. The shift toward value-based care, marked by strong incentives to improve quality measures, has renewed clinical emphasis on preventing HAIs.

A 2014 study published in The New England Journal of Medicine estimated 722,000 healthcare-associated infections occurred in acute care hospitals in 2011 alone, resulting in 75,000 deaths. The U.S. healthcare system spends $9.8 billion annually to treat the five most costly HAIs, a third of which is attributed to surgical site infections alone, according to a 2013 study in JAMA Internal Medicine.

CMS' Value-Based Purchasing program adjusts Medicare payments to hospitals based on a set of quality performance measures, which include infection rates. More than 1,600 U.S. hospitals with low infection rates will receive a positive payment adjustment under the program in fiscal year 2017, with the highest performing hospitals receiving an adjustment of more than 4 percent. On the other hand, about 1,300 hospitals with high infection rates will be financially penalized. These financial consequences drive the need for hospitals to follow thorough sterilization processes, which must be supported by the proper sterile processing equipment.

2. An aging population. "One factor that drives most change in all hospitals today is an aging population," says Ric Rumble, president and CEO of TS03 Corp., a Quebec City, Canada–based supplier of sterile reprocessing solutions.

By 2029, more than 20 percent of the U.S. population will be over the age of 65, according to data from the U.S. Census Bureau. This aging patient population generally requires the most medical services, including surgical time, which in turn spurs the need for quicker surgeries using more complex minimally invasive devices that require more difficult sterilization processes, according to Mr. Rumble.

3. Consumerism. Patient expectations have changed dramatically in the last 10 years. Patients today believe their healthcare should be quick, convenient and as painless as possible. Minimally invasive surgery aims to meet these expectations, according to Mr. Rumble. Innovative devices and surgical techniques give patients the quick, yet safe, procedures they desire. However, the tools required to complete these surgeries have grown more complicated, and thus present new challenges to effectively sterilize, according to Mr. Rumble.

"There is less trauma, and the patient is released in a much more timely fashion," he says. "But these procedures require more delicate surgery and very different instrumentation, which drives a need for more sterile processing staff."

4. High employee turnover. "The challenge with many sterilization departments is that they have a reasonably high turnover rate," Mr. Rumble says.

The Bureau of Labor Statistics projects 52,500 sterile processing technicians work in the U.S. However, continuous advancements in surgical devices have fueled a major demand for highly trained central service technicians, which many hospitals struggle to meet or maintain. Hiring and training new employees is time-consuming and costly task for hospitals to regularly conduct, but wise investments in sterile processing equipment can offset human capital costs amid periods of high turnover.

Keeping up-to-date with best practices

It is crucial hospitals stay up to date with recommended guidelines and best practices for proper sterilization amid such a constantly changing field.

"This is not a stagnant industry," Mr. Rumble says. "Instruments are constantly changing. Manufacturers are always making small tweaks to products."

To keep up with these changes and ensure devices are properly cleaned, sterilization departments should first reference a device's operations manual. Manufacturers include updated sterilization instructions in these manuals that correspond to any physical changes made to the device. Manufacturers typically feature the most up-to-date instructions on their websites.

Sterilization best practices are also detailed in the Association for the Advancement of Medical Instrumentation (AAMI) standards guide and the Association of periOperative Registered Nurse's (AORN) standards and recommended practices. A sterile processing manager should ensure the department is following the most recent policies and procedures that reflect both changes to the manufacturer's instructions for use and recommended practices, according to a 2014 article published in OR Management.

Sterile processing managers should also regularly review evidence-based research on sterilization processes and equipment to stay informed of updates and make corresponding changes to their sterilization processes, according to Mr. Rumble.

"Look for printed materials," he says. "Is there a substantial amount of literature published in this area? Is there an established hospital practice?"

Evidence-based research, combined with the most recent IFUs and best practice guidelines, enable hospitals to ensure they're providing the safest, most thorough sterilization services possible.

Purchasing the right sterilization equipment for your hospital

Healthcare leaders should purchase sterilization equipment and medical instruments based on their organization's particular surgical caseload and business goals, according to Mr. Rumble.

He estimates sterilization equipment has a lifetime of six to 10 years of use before needing replacement. When looking for a replacement, hospitals should consider three major factors.

1. Caseload. The type and amount of sterilization equipment a hospital needs depends on how many surgical procedures clinicians perform daily, as well as turnaround time between procedures.

2. Clinical convenience. Sterilization equipment today can process numerous types of instruments on the same machine, according to Mr. Rumble. "You want the equipment to do as much as it can," he says. Hospitals should assess their own surgical caseloads and identify commonly used instruments to ensure their new sterilization equipment can effectively and efficiently process the instruments they need in a timely manner. The equipment they purchase will also depend on the maximum size and length of the tools they use, as well as how much space the sterilization department has available to house the machinery.

3. Cost. Hospitals need to consider how they can implement more sterilization services with fewer dollars, according to Mr. Rumble. Those with a tight budget may want to purchase refurbished machinery to cut down on upfront costs. Hospitals should also ensure the equipment they purchase offers generic replacement parts to make any future repairs more cost effective. While new sterilization equipment represents a large upfront investment, over time the technology can lower costs by preventing HAIs and the expensive care associated with these infections, says Mr. Rumble.

Conclusion

"It's an exciting time in our industry," says Mr. Rumble. "The sterile processing department is becoming critical to the operating room." Effective sterile processing is crucial for hospitals to reduce infections and provide exceptional patient care, as well as lower treatment costs and maximize reimbursements under value-based care. Hospitals must acknowledge the numerous factors driving change in the sterilization processing field. Ultimately, hospitals with sterile processing departments that can respond to these constant changes — updating their sterilization procedures and machinery accordingly — will be most successful in preventing infections and reducing costs.

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